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Warfarin is the most commonly prescribed oral anticoagulant in Indonesia. However, the time in the therapeutic range (TTR) remains low across different countries worldwide. This study aimed to analyze the challenges associated with achieving optimal warfarin control. The analysis consisted of two distinct stages. The first stage was a prospective observational study that aimed to analyze anticoagulation control, dosing consistency, INR monitoring compliance, medication adherence, and knowledge of warfarin. Meanwhile, in the second stage, focus group discussion was used to propose strategies for overcoming the challenges. The result showed that the average TTR was 49.4 ± 32.1, where only 37.5% of patients had values = 65%. The average dosing consistency obtained was 62.33 ± 32.42%. The majority of patients with supratherapeutic INR values required a 1-month monitoring interval after dose adjustment. Further analysis indicated that only 43.8% of patients were classified as adherent and 39.5% had good knowledge of warfarin, suggesting the level of medication adherence and knowledge was not optimal. Approximately 14.6% of patients received other drugs that potentially interacted with warfarin, causing fluctuations in INR. In conclusion, this study found several challenges associated with achieving optimal warfarin control including barriers to dosing consistency, INR monitoring, medication adherence, and knowledge of warfarin, as well as drug interactions. The proposed solution is a holistic approach combining multifaceted strategies to address each barrier. [ABSTRACT FROM AUTHOR]

To analyze the differences in the effect of dual antiplatelet post PCI on the percentage of aggregation in myocardial infarction patients with DM and non DM. Percentage of aggregation were analyzed using light transmission aggregometry (LTA) before loading dose, after PCI, and after maintenance dose of dual antiplatelet (aspirin 100mg and clopidogrel 75mg). Total 22 patients were participated in this study divided into 10 and 12 patients in diabetic and non diabetic group. Percentage of aggregation after taking dual antiplatelet maintenace dose decrease significantly in both group (p=0.006 in diabetic group and p=0.002 in non diabetic group). Mean reduction of percentage of aggregation in diabetic group (3.30±2.91%) is less than non diabetic group (6.83±5.97%). Statistical analysis shows that the mean reduction of percentage of aggregation between two groups were not significantly different (p>0.05). Mean percentage of aggregation after dual antiplatelet maintenance dose was higher in diabetic group and mean reduction of percentage of aggregation was higher in non diabetic group, although statistically in both group it is not significantly different. [ABSTRACT FROM AUTHOR]